The duration related complications of diabetes mellitus include retinopathy, nephropathy, neuropathy and macro-vascular disease affecting the vascular and central nervous systems. The management of end-stage diabetic nephropathy is a major therapeutic challenge; however, renal transplantation is felt by this group of investigators to be the method of choice. The effect of uremia on diabetic retinopathy and visual acuity has not been determined. This study proposes to evaluate the visual status in uremic diabetics by thorough ophthalmic examination, with photographic and angiographic documentation, in a longitudinal manner. The effect of uremia and systemic hypertension on the best-corrected visual acuity and diabetic retinopathy will be determined. The effect on correction of uremia, by either chronic hemodialysis or renal transplantation, on the visual status of these patients will be determined. This information may permit us to establish a more rational basis for the timing of transplantation. As vocational rehabilitation following renal transplantation in diabetics is largely dependent on visual acuity, the information obtained from the proposed study may allow the development of methods resulting in preservation of vision in the uremic diabetic with an attendant improvement in rehabilitation.